Healthcare Provider Details

I. General information

NPI: 1306768874
Provider Name (Legal Business Name): RYAN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 SAVIN AVE
WEST HAVEN CT
06516-4936
US

IV. Provider business mailing address

622 SAVIN AVE
WEST HAVEN CT
06516-4936
US

V. Phone/Fax

Practice location:
  • Phone: 203-933-7095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RYAN KU
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-679-1120